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Extensor Tendon Injuries (Hand)

Introduction

An extensor tendon injury occurs when the tendon is torn, cut or otherwise detached.  The extensor tendons attach to the back of your fingers and thumbs.  They allow your fingers and thumbs to straighten and perform fine coordinated movements.  Extensor tendon injuries can result from trauma, burns, or arthritis.

Extensor tendon injuries cause loss of movement, pain, and swelling.  Some extensor tendon injuries are treated with splinting and hand therapy.  Surgery may be necessary in cases of tendon separation, fracture, or malalignment.

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Anatomy

Your hand is composed of many bones that provide structure for your wrist and fingers.  Your fingers and thumbs are made up of bones called phalanges.  The bones are connected with strong ligament tissues.  Tendons are strong fibers that attach your muscles to your bones and allow movement.  Your hand also contains nerves, blood vessels, and fat.  The skin that covers your hand protects it from the environment.
 
Your extensor tendons begin in your forearm and continue to the back side of your fingers and thumb.  As the extensor tendons reach your fingers, they become flat and thin.  They are located just underneath the skin.  The extensor tendons are attached to your phalanges via a complex system.  The extensor tendons allow your fingers and thumbs to straighten and perform fine coordinated movements.  
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Causes

Arthritis, burns, and injuries, such as cuts or jammed fingers, can cause extensor tendon injury.  Boutonniere deformities and mallet finger injuries are specific types of extensor tendon injuries.  An extensor tendon may be partially or completely cut.  It can remain intact but pull a piece of bone away from where it attaches on the phalanx.  This is called an avulsion fracture.
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Symptoms

An extensor tendon injury can cause your finger or hand to feel painful and swollen.  It may be difficult or impossible for you to extend your finger. 
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Diagnosis

Your doctor can diagnose an extensor tendon injury by reviewing your medical history and examining your hand.  X-rays can identify an avulsion fracture or joint malalignment.

 
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Treatment

Many factors affect the seriousness of an extensor tendon injury such as associated fractures, infection, the degree of tendon separation, and if the tendon was cut or torn.  Treatment is individualized and your doctor will discuss your options with you.  Nonsurgical treatments for extensor tendon injuries include splinting and hand therapy.
 
Splinting positions your finger to allow the extensor tendon to heal.  It is important not to remove the finger splint at anytime, even while you shower.  If the finger splint is removed, even for the shortest amount of time, the treatment is disrupted and the process must start all over.  You will wear your splint for several weeks full-time, followed by a part-time splint schedule.  A dynamic splint may be used to allow movement while protecting the healing tendon.
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Surgery

Surgery is necessary for many extensor tendon injuries.  The ends of separated extensor tendons can be stitched together.  In rare cases, the extensor tendon may be tightened or repaired with a graft.
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Recovery

Splinting and surgical treatments are usually followed by hand therapy.  A hand therapist will show you exercises to stretch and strengthen your joints.  The other joints in your fingers may become stiff and benefit from hand therapy as well.  It can take an extensor tendon injury several months to recover from completely.  Healing is an individualized process.  Your doctor will let you know what to expect.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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